Rad 102 Final Exam Prep PDF

Rad 102 Final Exam Prep TERM AND PRINCIPLES **Anatomy**: The term applied to the science of the structure of the body **Physiology**: The study of the function of the body organs **Osteology**: The detailed study of the body of knowledge relating to the bones of the body - Bone functions -...

Rad 102 Final Exam Prep TERM AND PRINCIPLES **Anatomy**: The term applied to the science of the structure of the body **Physiology**: The study of the function of the body organs **Osteology**: The detailed study of the body of knowledge relating to the bones of the body - Bone functions - Skeletal divisions - 206 bones - Axial - Supports/protects head and trunk - Central axis of body - Skull, Vertebral columns, Ribs, and Sternum - Appendicular - Provides means for movement - Limbs - Shoulder/Pelvic Girdles - General bone features - Bone development - Classification of bones Body Planes - Sagittal: Right and Left (midsagittal) - Coronal: Anterior and Posterior (midcoronal) - Horizontal: Superior and Inferior (crosswise) - Oblique: Angle Anatomic Relationship - Anterior (ventral): front of body - Posterior (dorsal): back of body - Caudad: away from head - Cephalad: towards head - Inferior - Superior - Contralateral: opposite side of the body - Ipsilateral: same side of body - Lateral: outside - thumb - Medial: towards middle of body - Deep: towards bone - Superficial: skin - Distal: farthest from point of attachment/origin - Ankle is distal to the knee - Proximal: closest to point of attachment/origin - Elbow proximal to wrist - Dorsum: back of hand (posterior) OR top of foot - Palmar: palm of hand (anterior) - Plantar: bottom of foot Body Movement - Abduct: away from body - Adduct: towards body - Extension: straighten joint - Flexion: bend joint - Evert: turn out - Invert: turn in - Pronate: place palm down - Supinate: place palm up - Rotate - Circumduction: circular motion of limb - Dorsiflexion: toes to sky - Plantar Flexion: pointed toes Projection: path of the CR as it exits the x-ray tube, passing through the patient to the IR - Identified by the entrance and exit points of the body - Based on anatomic position - AP - Cr enters Anterior side, exits Posterior - PA - CR enters Posterior, exits Anterior - Lateral - CR enters side of body, passes transversely across coronal plane - AP Oblique - PA Oblique - Axial - Longitudinal angle of CR of 10+ degrees or angulation of body - Tangential Positioning: Minimum of 2 projections 90 degrees from each other (3+ projections for joints) - Structures superimposed - Localization of lesions or foreign bodies - Determination of alignment of fractures - Exceptions: Postreduction upper/lower limbs, pelvis, KUB Markers - The markers should be placed near the area being imaged, usually at the outside edges of the body part or near joints. - They should be placed in a visible location on the body, such as near the skin surface, to ensure that they are easily seen on the X-ray image. - The markers should be placed in a consistent position for each exam so that the radiologist can easily compare images taken at different times. - If multiple markers are used, they should be placed in a consistent pattern to make it easier for the radiologist to interpret the image. CHEST Divisions - Bony thorax- protective framework - Ribs - Posterior end is higher - 1^st^ rib curves down sharply - Must see 10 posterior ribs above diaphragm - Sternum - Thoracic Vertebrae - Respiratory- lungs and airway - Continuous structure from nose/mouth to lungs - Pharynx: muscle lines space connects nose/mouth to larynx and esophagus - Epiglottis acts as a lid covering opening to prevent food/liquid from entering resp. tract - Larynx: composed of groups of cartilage - Thyroid (largest, located at C5) - Trachea: muscular tube with C shaped cartilage rings - Bronchi - Right larger and more vertical than left, divides into 3 for each lobe - Left divides into 2, one for each lobe of lung - Branch into smaller divisions (bronchioles) until they become terminal sacs (alveoli) where O2 and CO2 exchange - Lungs - Pleura: parietal (outermost), pleural cavity, and pulmonary-visceral - Hilum - Apex - Base - Costophrenic angles - Diaphragm (right higher than left due to liver) - Fissures - Mediastinum- space between lungs - Trachea, esophagus, thymus (children), heart/great vessels A diagram of the internal organs of a person Description automatically generated - Inspiration: Full lungs, low diaphragm, belly out - Expiration: empty lungs, high diaphragm, belly in - Chest exam done erect for air-fluid levels, allows diaphragm to move down, and prevention of pulmonary vessel engorgement Landmarks - Jugular notch - Vertebra Prominenes (C7) - Xiphoid Process Technical Factors - kVp 110-125 - Grid - 14x17 CW or LW for PA, LW for lateral - 72 SID - Inspiration (r/o pneumothorax is expiratory) Evaluation - Entire lung included - No rotation - Scapulae removed from lungs - No motion - SC joints must be equidistant from spinous processes - Chin extended - Minimize breast shadows Special Projections - Left Lateral Decubitus - Air/fluid levels - Air=upside - Fluid=downside - AP Lordotic - Projects clavicles above apices - Pt leans back or angle 15-20 degrees cephalic ABDOMEN Contrast - Soft tissue differentiation by - Psoas mucles - Lower margin of liver - Kidney outlines - Transverse processes of lumbar vertebrae Divisions - Outer layer=parietal peritoneum (lines abdominopelvic walls) - Inner layer= visceral peritoneum (wraps organs) - In between= peritoneal cavity - Abdominal cavity - Stomach: when empty is collapsed except for air in upper portion - Small intestine - Duodenum, Jejunum, Ileum - Normally little air, large amounts may indicate obstruction/infection - Large intestine - Begins in RLQ - A diagram of the human body Description automatically generated - Liver: Largest solid organ of body, RUQ - Gallbladder: lies under inferior surface of liver - Spleen: part of circulatory system, LUQ, only seen if enlarged, easily lacerated with rib - Pancreas: elongated gland, lies transverse within abdomen, head ends in duodenum - Kidneys - Bony - Lumbar spine, pelvis, sacrum & coccyx - Pelvic cavity - Rectum - Sigmoid - Urinary bladder - Kidney (right lower than left), ureters, bladder - Reproductive organs - Landmarks - Iliac crest (L4-L5) - Asis - Greater trochanter - Symphysis pubis - Ischial tuberosity - Xiphoid process (T9-T10) - Inferior costal margin (L2-L3) - Muscles - Diaphragm: movement controlled by breathing - Psoas: one on each side of vertebrae Quadrants - RUQ - RLQ - LUQ - LLQ Right Hypochondriac \| Epigastric \| Left Hypochondriac Right Lumbar \| Umbilical \| Left Lumbar Right Iliac \| Hypogastric\| Left Iliac Positioning - Expiration - 14x17 LW - 40 SID - kVp 80-85 mAs 10-40 - Central ray to iliac crest (AP/PA supine, 2 in. below for erect) - 2^nd^ marker is greater trochanter - Left lateral decub - 2 in. above crest - Free air will rise under the right diaphragm and not be confused with air in stomach - Supine/Prone want to see symphysis pubis - Erect/decub want diaphragm Pathology - Peritonitis (inflammation) - **[Ascites (fluid in peritoneum)]** - Pneumoperitoneum (free air in peritoneum) - Fistula (abnormal passage between two organs) - **[Intussusception (telescoping of bowel)]** - **[Volvulus (twisting of intestine)]** - **[Ileus (obstruction by lack of intestinal motility )]** - AAA HAND/FINGER/WRIST Phalanges (fingers)- 14 \*long bones Metacarpals (palm)- 5 \*long bones Carpals (wrist)- 8 Total-27   Joints classified as synovial, diarthrotic, or freely movable joint, hinge type Metacarpal has tuft (head), shaft and base. Head articulates with phalanges Carpals - Proximal row (from thumb to pinky) - **Scaphoid** (navicular), **Lunate** (semilunar), **Pisiform, Triquetrum** - Distal row - **Trapezium, Trapezoid, Capitate, Hamate** - Capitate is largest Carpal Sulcus (Gaynor-Hart Method) - Hyperextended hand - Pisiform and trapezium are most anterior carpals Technique - 60 kVp for short-scale contrast *(high contrast)* - Small body parts = low mAs - Bony anatomy = *low kV (gives us high contrast -- white against black background)* - Smaller the part, the lower the mAs - As body part gets thicker, mAs increases PA Projection (Hand) - Palm down, Hand & fingers flat - CR to 3rd MCP joint - 40 SID - Distal radius and ulna to distal phalanges included; heads of metacarpals separated Oblique Hand - Hand rotated 45°, Fingers extended - CR to 3rd MCP joint - Collimate - Distal radius and ulna to distal phalanges included; 3-5^th^ metacarpals slightly superimposed AP Oblique (Norgaard Method) - Also called "ball-catchers position" - Both hands supinated, then rotated medially 45 degrees - CR directed to mid-receptor - Demonstrates early rheumatoid arthritis Lateral Hand - Hand 90 degrees, fingers separated - Special Flexion and extension used for foreign bodies and anterior/posterior fracture displacement - Distal radius and ulna to distal phalanges included; metacarpals superimposed AP\* Thumb - Nail side down, CR to MCP joint - Must include 1^st^ metacarpal and trapezium Oblique Thumb - CR to 1^st^ MCP joint, hand placed like PA hand Lateral Thumb - Hand internally rotated, nail perpendicular - CR to 1^st^ MCP PA\* Fingers 2-5 - CR to PIP joint of affected digit - Keep fingers parallel to the IR for all projections - Use immobilization when needed - Sponges, tape, wooden bite sticks, etc. Oblique and Lateral Projections - 2nd digit - rotate medially 45 degrees(internally) - CR to 2^nd^ PIP - 3rd digit - either direction is OK - 4th & 5th digit - rotate laterally (externally) *\* Remember to keep finger fully extended & parallel to the table* PA Wrist - Hand pronated - CR mid carpal - fingers flexed to - reduce OID - include distal 1/3 - of radius & ulna to - prox. metacarpals Oblique Wrist - 45° lateral rotation (PA) - CR mid carpal AP Oblique Wrist - Supinate hand - Internally rotate 45° - CR mid carpal - best demonstrates the pisiform free of superimposition Lateral Wrist - Rotate 90° - Styloid processes superimposed - Wrist straight - CR mid-carpal Post reduction - Two projections only - PA & lateral - Adjust technique - Fiberglass cast - increase 4 - 6 KV - Plaster cast - 2x MAS *or* up 8 - 10 KV Stecher Method (Navicular/Schapoid) - Angle CR 20° towards elbow *or* - Elevate hand 20°, no CR angle Pathology - Colles fracture - transverse fracture of the distal radius, usually with backward displacement of the hand. - Boxer's Fracture - transverse fracture of the base of the 5th metacarpal (most common fracture of the hand) - Punch an object with a closed fist. 4^th^ or 5^th^ metacarpal takes impact and breaks at neck - Smiths fracture: fracture from falling on back side of hand/wrist - Scaphoid fracture Bone Age Study (Greulich and Pyle) - Single PA projection of the (non dominant) hand and wrist - Demonstrates the degree of ossification in the hand and wrist (skeletal maturity) ELBOW/FOREARM/HUMERUS Forearm Consists of two long bones - Ulna (medial) - Proximal - Olecranon process - Semilunar notch - Radial notch - Coronoid process - Shaft - Distal - Head - Styloid process - Radius (lateral) Humerus - Long bone in the upper arm - Head articulates with scapula to form shoulder joint - Distal end forms part of elbow joint - Lateral epicondyle - Lateral condyle - Capitellum (radius) - Medial epicondyle - Medial condyle - Trochlea (ulna) - Olecranon fossa - Coronoid fossa - Proximal - Proximal anatomy - Head - Anatomic neck - Surgical neck - Greater tubercle - Lesser tubercle - Bicipital groove AP Forearm - Hand supinated - CR midshaft - 40 SID - Light field should include about 2 inches of each joint - Collimate on sides to about 1 inch enough for marker **Structures Shown/ Evaluation Criteria** - **Entire forearm, including wrist and distal humerus** and proximal row of slightly distorted carpal bones - Slight superimposition of the radial head, neck, and tuberosity over the proximal ulna - No elongation or foreshortening of the humeral epicondyles - Partially open elbow joint if the shoulder was placed in the same plane as the forearm - **Open radioulnar space** - Bony trabecular detail and surrounding soft tissues Lateral Forearm - Elbow flexed 90 degrees - Hand/wrist lateral - CR midshaft - 40 SID - Marker for laterality being imaged - Light field should include about 2 inches of each joint **Structures Shown/Evaluation Criteria** - Entire forearm, including wrist and distal humerus in a true lateral position: - Superimposition of: - the radius and ulna at their distal end - the radial head over the coronoid process - humeral epicondyles - Radial tuberosity facing anteriorly - Bony trabecular detail and surrounding soft tissues AP Elbow - Humerus and forearm on same plane - Hand supinated - CR mid elbow - Light field about 3 inches above and below joint - 1 inch collimation on sides for marker placement - **Condyles parallel to IR** - Patient lean laterally until the humeral condyles are parallel with the plane of the IR **Structures Shown/Evaluation Criteria** - Radial head, neck, and tuberosity slightly superimposed over the proximal ulna - ***Elbow joint open*** and centered to the central ray - **No rotation of humeral epicondyles** - coronoid and olecranon fossae approximately ***equidistant*** to epicondyles - Bony trabecular detail and surrounding soft tissues Lateral Elbow - Humerus and forearm on same plane - Elbow flexed 90 degrees - Hand/wrist lateral - CR mid elbow - **Condyles perpendicular to IR** **Structures Shown/Evaluation** - Elbow joint open and centered to the central ray - Elbow in a true lateral position: - Superimposed humeral epicondyles - Radial tuberosity facing anteriorly - Radial head partially superimposing the coronoid process - **Olecranon process in profile** Oblique Elbow (Medial Rotation-Internal) - Humerus and forearm on same plane - Extend arm - Hand pronated - ***Note:*** Pronation of the hand only may not rotate the elbow joint the necessary 45 degrees to demonstrate the ulnar coronoid process in profile - CR mid elbow - **Condyles 45 degrees to IR** **Structures Shown/Evaluation Criteria** - Elbow joint open and centered to the central ray - 45-degree medial rotation of elbow: - ***Coronoid process in profile*** - Elongated medial humeral epicondyle - Ulna superimposed by the radial head and neck - Trochlea - *Olecranon process within the olecranon fossa* - Bony trabecular detail and surrounding soft tissues Oblique Elbow (internal) - Humerus and forearm on same plane - Extend arm - Hand supinated/thumb down - CR mid elbow - **Condyles 45 degrees to IR** **Structures Shown/ Evaluation Criteria** - Elbow joint open and centered to the central ray - 45-degree lateral rotation of elbow: - **Radial head, neck, and tuberosity projected free of the ulna** - Elongated lateral humeral epicondyle - Capitulum - Bony trabecular detail and surrounding soft tissues What do you do when pt cannot fully extend arm? - 2 AP projections - Forearm on IR - Humerus on IR - Requires that *distal humerus and proximal forearm imaged separately* Axiolateral (coyle) - **Useful in trauma to demonstrate radial head and coronoid process** - on patients who cannot fully extend the elbow for medial and lateral oblique projections - **Radial head** - Elbow flexed 90 degrees - Hand pronated - CR angled 45 degrees toward shoulder entering joint at mid-elbow - ***Radial head, neck, and tuberosity in profile and free from superimposition*** - **Coronoid process** - Elbow flexed 80 degrees - Hand pronated - CR angled 45 degrees away from shoulder entering joint at mid-elbow - **Coronoid process in profile and elongated** AP Humerus - Place top border of IR or light field approximately 1½ inches above humeral head - Slightly abduct humerus from body and supinate hand - CR mid humerus - **Condyles parallel to IR** - **Greater tuberosity in profile** **Structures Shown/Evaluation Criteria** - Elbow and shoulder joints - **Humeral condyles without rotation** - **Humeral head and greater tubercle in profile** - Outline of the lesser tubercle, located between the humeral head and the greater tubercle - Bony trabecular detail and surrounding soft tissues Lateral Humerus - Place top border of IR or light field approximately 1½ inches above humeral head - Abduct and flex elbow 90 degrees, internally rotate arm and place posterior aspect of hand on hip (non trauma only) - (trauma) hand on abd. -- pt facing IR may be easier\...next slide - Condyles perpendicular to IR - Lesser tubercle in profile over glenoid fossa **Structures Shown/Evaluation Criteria** - Elbow and shoulder joints visible, but slightly distorted due to beam divergence - **Superimposed humeral condyles** - **Lesser tubercle in profile on medial aspect** - Greater tubercle superimposed over the humeral head - Bony trabecular detail and surrounding soft tissues Transthoracic lateral - Trauma pt - For proximal (upper) humerus - CR to surgical neck - Affected arm against IR - Unaffected arm elevated - Humerus will be in lung field Breathing technique used to blur ribs SHOULDER/CLAVICLE/SCAPULA - Humerus is ***not*** considered to be part of the shoulder girdle - Because the upper portion articulates with the shoulder girdle, proximal humeral anatomy is considered in evaluation of images of the shoulder joint Joints - Sternoclavicular joints (gliding) - Acromioclavicular joints (gliding, rotary) - Glenohumeral joint/Scapulohumeral joint (ball&socket) Girdle - Clavicle - Acromial end (humerus) - Shaft - Sternal extremity - Scapula (T2-T7) - Superior border - Vertebral border (medial) - Axillary border (lateral) - Superior angle - Inferior angle - Lateral angle - Body - Wing - Coracoid process - Scapular notch - Acromion - Glenoid fossa - Supraspinatus fossa - Infraspinatus fossa - Spine Clavicle \*PA preferred to reduce OID - AP/PA 10x12 cw - AP/PA Axial 10x12 cw - CR-mid-shaft - Axial projection uses 15-30° cephalic angle (PA caudal) - Thin shoulder -- more angle - Thick shoulder -- less angle - Projects clavicle above scapula to eliminate superimposition Scapula - AP 10x12 lw - Entire scapula demonstrated - Lateral border of scapula free of ribs and lungs - Arm abducted & flexed 90°("stop sign" position) - CR 2 inches inferior to coracoid process - Text recommends shallow breathing to blur ribs - Lateral 10x12 lw - Anterior oblique position 45-60° - RAO for right scapula - LAO for left scapula - 3 arm positions to choose from - Arm across chest - Arm behind back - Arm over head - CR-mid-medial border of scapula - Palpate scapula and place flat surface perpendicular to the IR - For body of scapula AC Joints - Views 72-inch SID (beam divergence) - AP with weights 14 x 17 CW - AP without weights 14 x 17 CW - Wall bucky- *Upright required*, because supine position will reduce dislocation, if present - CR- jugular notch - If hypersthenic may require - Left- with and without weights - Right- with and without weights - AC joint separation, clearly seen on the images with weights - Image marked w/ and w/out weights Shoulder - 40 SID - Non-trauma - AP internal 10x12 cw - humeral condyles perpendicular to IR (pronate hand) - CR 1 inch inferior to coracoid process - Epicondyles are perpendicular to IR - Lesser tuberosity in profile - AP external 10x12 cw - humeral condyles parallel to IR (supinate hand) - CR 1 inch inferior to coracoid process - Epicondyles are parallel to IR - Greater tuberosity in profile - Trauma - AP neutral 10x12 cw - Neutral -- humeral condyles 45° to IR (palm of hand against thigh) - CR 1 inch inferior to coracoid process - Epicondyles approximately 45° angle to IR - Y-view 10x12 lw - Acromion and coracoid process form a Y shape - Position is particularly **useful to diagnose shoulder dislocations** - 45 to 60 degree rotation - Palpate scapula and place flat surface perpendicular to the IR - *Arm position is not critical* - **Humeral head and glenoid cavity superimposed** - **Humeral shaft and scapular body superimposed** - *No superimposition of the scapular body over the bony thorax* - **Acromion projected laterally and free of superimposition** - Coracoid possibly superimposed or projected below the clavicle - **Scapula in lateral profile** with **lateral and vertebral borders superimposed** - Transthoracic lateral - Shoulder and proximal humerus is projected through the thorax - - Additional views - Grashey method 10x12 cw \*GLENOID - RPO or LPO - 35 to 45 degrees posterior oblique position - ***Affected shoulder closer to IR*** - Rotation should place ***scapula parallel to IR*** - Palm of the hand on the abdomen - - Inferosuperior Axial 10x12 cw - Lawrence method, CR enters axilla -